Efficacy of Bisoprolol in Patients After Acute MI with LV Systolic Dysfunction

Beta-Blockers in Patients After AMI

Beta-blockers (BB) are a cornerstone in the management of heart failure, and their effects in the acute coronary syndrome (ACS) are well-studied. Oral BBs are a crucial part of primary pharmacotherapy and secondary prevention after AMI, irrespective of its severity. BB administration is recommended early after AMI, provided there are no contraindications.

According to the guidelines of the European Society of Cardiology (ESC) for the management of AMI issued in 2017, routine BB administration should be considered in patients with ST-segment elevation and is recommended in patients with reduced LVEF. However, there is still a lack of data on the use of bisoprolol in acute situations, when patients with left ventricular systolic dysfunction are admitted to intensive care units due to recent ACS.

For these reasons, the authors of the study described below evaluated the impact of one year of bisoprolol treatment on heart rate, LVEF, and metabolic indicators (HbA_1c level and lipid profile) in patients after ACS with LVSD.

Study Methodology and Parameters

This non-interventional retrospective monocentric study was based on the collection of secondary data, where researchers gathered demographic information and data on comorbidities, hemodynamics, concurrent medications, and evaluated the efficacy of one-year treatment of patients after ACS with LVSD (e.g., heart failure with mid-range ejection fraction [HFmrEF] or HF with reduced EF [HFrEF]; LVEF < 50%) with oral bisoprolol (1.25 mg, 2.5 mg, 5 mg, and 10 mg). Bisoprolol was initiated during hospitalization for myocardial infarction or at discharge.

Researchers evaluated the data records of 400 adult patients who were first prescribed bisoprolol during hospitalization for AMI with LVSD between August 2016 and June 2019. The monitored parameters included changes in LVEF, heart rate (primary endpoints), lipid profile, HbA_1c values, and deviations of the ST segment from the J point (end of the QRS complex) after one year of treatment compared to baseline values (secondary endpoints).

Results

The median age of the study cohort was 55.28 ± 7.9 years, with 29.75% being women. At the end of the one-year bisoprolol treatment (median dose 4.15 + 1.4 mg), a significant improvement in LVEF (48.73 ± 5.5% vs. 41.45 ± 5.1%; p = 0.0001) and a significant reduction in heart rate (76.73 ± 4.6 vs. 85.06 ± 5.64 beats/min; p = 0.0001) were observed compared to baseline values. The NYHA class improved from 1.6 + 0.5 to 1.11 + 0.31.

Bisoprolol, administered alongside guideline-directed medical therapy (GDMT), did not affect HbA_1c levels, while serum lipid concentrations improved due to statin use. The electrocardiographic examination revealed a smaller maximal ST deviation at the J point after one year of treatment (0.05 + 0.22 vs. 0.29 + 1.5 mm; p = 0.0001).

Conclusion

Administering bisoprolol in conjunction with GDMT in patients after acute myocardial infarction with left ventricular systolic dysfunction significantly improved LVEF values after one year. It also led to a significant reduction in heart rate and ST segment deviation at the J point without adverse effects on lipid levels or glycated hemoglobin.

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Sources:
1. Sharma K., Desai H., Sharma N. et al. To evaluate the ‘real world’ clinical performance of bisoprolol in post-myocardial infarction with left-ventricular dysfunction: TENACITY Study. Cardiolog Res Cardiovasc Med 2022; 7: 182, doi: 10.29011/2575-7083.100082.
2. Ibanez B., James S., Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (2): 119–177, doi: 10.1093/eurheartj/ehx393.